Healthcare Provider Details

I. General information

NPI: 1376702084
Provider Name (Legal Business Name): FALLS NEUROPSYCHOLOGY AND PSYCHOTHERAPY ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 04/17/2024
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8216 CREEDMOOR RD STE 101
RALEIGH NC
27613-1391
US

IV. Provider business mailing address

8216 CREEDMOOR RD STE 101
RALEIGH NC
27613-1391
US

V. Phone/Fax

Practice location:
  • Phone: 919-870-0264
  • Fax: 919-870-0293
Mailing address:
  • Phone: 919-870-0264
  • Fax: 866-777-4638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3043
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004784
License Number StateNC

VIII. Authorized Official

Name: MS. DENISE QUIRK BUNDICK
Title or Position: CO-OWNER
Credential: LCSW
Phone: 919-870-0264